Pelvic incidence in thoracolumbar fractures : Is there an impact

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Published Oct 30, 2024
https://doi.org/10.62438/tunismed.v102i11.4941
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Vol. 102 No. 11 (2024): Tunis Med nov 2024

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Mourad Aoui
Department of Orthopaedic Surgery and Traumatology, Habib Bourguiba University Hospital, Sfax, Tunisia
Nizar Sahnoun
Department of Orthopaedic Surgery and Traumatology, Habib Bourguiba University Hospital, Sfax, Tunisia
Cyrine Fourati
Department of Orthopaedic Surgery and Traumatology, Habib Bourguiba University Hospital, Sfax, Tunisia
Mohamed Abid
Department of Orthopaedic Surgery and Traumatology, Habib Bourguiba University Hospital, Sfax, Tunisia
Hassib Keskes
Department of Orthopaedic Surgery and Traumatology, Habib Bourguiba University Hospital, Sfax, Tunisia

Abstract

Introduction : In trauma, we can perform a lateral radiography of the lumbosacral hinge taking the femoral heads if we include it in the initial lesion assessment. Thus, the pelvic incidence informs about the type of back as described by Roussouly.


Aim: To describe the clinical and radiological results of these types of back which are operated on for a thoracolumbar fracture.


Methods : We recorded the clinical, radiological data and the characteristics of the fracture of 120 patient operated on for a thoracolumbar spine fracture over a period of 14 years between February 2005 and July 2019. We studied the deformation according to Regional traumatic angulation (ART), Sagittal Farcy Index (SIF), Gardner Segment Kyphotic Deformity (GSKD). Functional evaluation was carried out according to the Denis Pain Scale. Radiological evaluation was based on relative gain and loss.


Results : In individuals with low pelvic incidence, a prevalence of 72% was observed for type A fracture, whereas types B and C accounted for 45.9% (P<0.05) for backs with high pelvic incidence. The Denis Pain Scale score indicated that 90% of individuals with low incidence backs had scores below 3, whereas only 65.6% of those with high incidences had scores below 3 (P<0.05). The loss of correction for backs with low incidences was measured at 1.2°, while for backs with high incidences, it was 3° (p<0.05).


Conclusion : Fractures on backs with low pelvic incidence considered as stiff backs are more frequently of type A, with better functional results and less losses.

Keywords:

thoracolumber, vertebral fracture, X-rays

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References

  1. Argenson C, Lassale B. [Recent fractures of the thoracic and lumbar spine with or without neurologic disorders]. Rev Chir Orthop Reparatrice Appar Mot. 1996;82 Suppl 1:61‑127.
  2. Kraemer WJ, Schemitsch EH, Lever J, McBroom RJ, McKee MD, Waddell JP. Functional outcome of thoracolumbar burst fractures without neurological deficit. J Orthop Trauma. 1996;10(8):541‑4.
  3. Zileli M, Sharif S, Fornari M. Incidence and Epidemiology of Thoracolumbar Spine Fractures: WFNS Spine Committee Recommendations. Neurospine. déc 2021;18(4):704‑12.
  4. Duval-Beaupère G, Schmidt C, Cosson P. A Barycentremetric study of the sagittal shape of spine and pelvis: the conditions required for an economic standing position. Ann Biomed Eng. 1992;20(4):451‑62.
  5. Roussouly P, Berthonnaud E, Dimnet J. [Geometrical and mechanical analysis of lumbar lordosis in an asymptomatic population: proposed classification]. Rev Chir Orthop Reparatrice Appar Mot. nov 2003;89(7):632‑9.
  6. Roussouly P, Pinheiro-Franco JL. Sagittal parameters of the spine: biomechanical approach. Eur Spine J. sept 2011;20 Suppl 5(Suppl 5):578‑85.
  7. Jackson RP. Jackson sacral fixation and contoured spinal correction techniques. In: Lumbosacral and Spinopelvic Fixation. Marguiles, J. Y. Philadelphia: Lippincott-Raven; 1996. p. 357‑79.
  8. Steib JP, Charles YP, Aoui M. In situ contouring technique in the treatment of thoracolumbar fractures. Eur Spine J. mars 2010;19 Suppl 1(Suppl 1):S66-68.
  9. Berthonnaud E, Labelle H, Roussouly P, Grimard G, Vaz G, Dimnet J. A variability study of computerized sagittal spinopelvic radiologic measurements of trunk balance. J Spinal Disord Tech. févr 2005;18(1):66‑71.
  10. Roussouly P, Gollogly S, Berthonnaud E, Dimnet J. Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine (Phila Pa 1976). 1 févr 2005;30(3):346‑53.
  11. Le Huec JC, Aunoble S, Philippe L, Nicolas P. Pelvic parameters: origin and significance. Eur Spine J. sept 2011;20(S5):564‑71.
  12. Farcy JP, Weidenbaum M, Glassman SD. Sagittal index in management of thoracolumbar burst fractures. Spine (Phila Pa 1976). sept 1990;15(9):958‑65.
  13. Masmoudi S, Khlif MA, Abcha Y, Ellech H, Barsaoui M, Zitouna K. Brace treatment results of thoracolumbar vertebral osteomyelitis. Tunis Med. 5 mai 2023;101(5):515‑20.
  14. Korovessis P, Baikousis A, Koureas G, Zacharatos S. Correlative analysis of the results of surgical treatment of thoracolumbar injuries with long Texas Scottish rite hospital construct: is the use of pedicle screws versus hooks advantageous in the lumbar spine? J Spinal Disord Tech. juin 2004;17(3):195‑205.
  15. Blamoutier A, Milaire M, Garreau de Loubresse C, Lassale B, Deburge A. [Cotrel-Dubousset instrumentation in the treatment of thoracolumbar and lumbar spine fractures]. Rev Chir Orthop Reparatrice Appar Mot. 1992;78(8):529‑35.
  16. Gajjar SH, Menon HJ, Chaudhari N, Chaudhari V. Outcomes of Short Segment Posterior Instrumentation in Unstable Thoracolumbar Fractures. J Clin Diagn Res. nov 2016;10(11):RC04‑8.
  17. Chua MH, Hong R, Rydeth T, Vycheth I, Nang S, Vuthy D, et al. Spine Trauma as a Component of Essential Neurosurgery: An Outcomes Analysis from Cambodia. World Neurosurg. juin 2018;114:375‑80.
  18. Wang L, Li J, Wang H, Yang Q, Lv D, Zhang W, et al. Posterior short segment pedicle screw fixation and TLIF for the treatment of unstable thoracolumbar/lumbar fracture. BMC Musculoskelet Disord. 11 févr 2014;15:40.
  19. Gelb D, Ludwig S, Karp JE, Chung EH, Werner C, Kim T, et al. Successful treatment of thoracolumbar fractures with short-segment pedicle instrumentation. J Spinal Disord Tech. juill 2010;23(5):293‑301.
  20. El-Sharkawi M, Abdel Gawad M, El Sabrout AM, Hassan M. Short Versus Long Segment Fixation for Thoracolumbar Burst Fractures: A Randomized Controlled Trial. Egyptian Spine Journal. 1 oct 2017;24(1):6‑13.
  21. Alvine GF, Swain JM, Asher MA, Burton DC. Treatment of thoracolumbar burst fractures with variable screw placement or Isola instrumentation and arthrodesis: case series and literature review. J Spinal Disord Tech. août 2004;17(4):251‑64.
  22. CHATELLIER P, MISSOURY F, ANTOUN C, MEHDI M, HUSSON JL. Le fixateur interne de Dick dans le traitement des fractures de la charnière dorso-lombaire et du rachis lombaire. Débat. Communication lors d’une conférence présenté à: Congrès annuel de la Société d’orthopédie de l’Ouest (Angers 1997); 1997.
  23. Sapkas G, Kateros K, Papadakis SA, Brilakis E, Macheras G, Katonis P. Treatment of Unstable Thoracolumbar Burst Fractures by Indirect Reduction and Posterior Stabilization: Short-Segment Versus Long-Segment Stabilization. Open Orthop J. 15 janv 2010;4:7‑13.
  24. Dai LY, Jiang LS, Jiang SD. Posterior short-segment fixation with or without fusion for thoracolumbar burst fractures. a five to seven-year prospective randomized study. J Bone Joint Surg Am. mai 2009;91(5):1033‑41.
  25. Guigui P, Lassalle B, Deburge A. Fractures et luxations récentes du rachis dorsal et lombaire de l’adulte. In: Encyclopédie Médico-Chirurgicale. L’Encyclopédie Médico-Chirurgicale. Paris: Elsevier; 1998. p. 10.
  26. Sanderson PL, Fraser RD, Hall DJ, Cain CM, Osti OL, Potter GR. Short segment fixation of thoracolumbar burst fractures without fusion. Eur Spine J. 1999;8(6):495‑500.
  27. Argenson C, Puch J, de Peretti F, Perraud M, Cambas P. Le remodelage du canal vertébral après traitement des fractures du rachis thoracolombaire. Rev Chir Orthop. 1993;79(Suppl 1):120.
  28. Almigdad A, Alazaydeh S, Mustafa MB, Alshawish M, Abdallat AA. Thoracolumbar spine fracture patterns, etiologies, and treatment modalities in Jordan. J Trauma Inj. 30 juin 2023;36(2):98‑104.
  29. Steib JP, Aoui M, Mitulescu A, Bogorin I, Chiffolot X, Cognet JM, et al. Thoracolumbar fractures surgically treated by « in situ contouring ». Eur Spine J. déc 2006;15(12):1823‑32.
  30. Li X, Ma Y, Dong J, Zhou X gang, Li J. Retrospective analysis of treatment of thoracolumbar burst fracture using mono-segment pedicle instrumentation compared with short-segment pedicle instrumentation. Eur Spine J. oct 2012;21(10):2034‑42.
  31. Amelot A, Cristini J, Moles A, Salaud C, Hamel O, Bord E, et al. Non neurologic burst thoracolumbar fractures fixation: Case-control study. Injury. oct 2017;48(10):2150‑6.
  32. Withrow JS, Monterey MD, Narro A, Haley L, Martinez Cruz M, Budde B, et al. Characterization of the influence of spinopelvic parameters on thoracolumbar trauma. J Neurosurg Spine. 1 nov 2023;39(5):700‑8.
  33. Magerl F, Aebi M, Gertzbein SD, Harms J, Nazarian S. A comprehensive classification of thoracic and lumbar injuries. Eur Spine J. 1994;3(4):184‑201.
  34. Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine (Phila Pa 1976). 1983;8(8):817‑31.
  35. Vaccaro AR, Lehman RA, Hurlbert RJ, Anderson PA, Harris M, Hedlund R, et al. A new classification of thoracolumbar injuries: the importance of injury morphology, the integrity of the posterior ligamentous complex, and neurologic status. Spine (Phila Pa 1976). 15 oct 2005;30(20):2325‑33.
  36. McCormack T, Karaikovic E, Gaines RW. The load sharing classification of spine fractures. Spine (Phila Pa 1976). 1 août 1994;19(15):1741‑4.